Abstract 1342: Initial Left Ventricular Mass Predicts Probability of Optimal Blood Pressure Control in Arterial Hypertension
Background: Left ventricular (LV) hypertrophy (LVH) is a marker of target organ damage in hypertension and helps stratify cardiovascular (CV) risk. LV mass (LVM) is also frequently increased in subjects developing subsequent hypertension. There is no information on whether increased LVM predicts poor blood pressure (BP) control.
Methods: We evaluated risk of uncontrolled BP in relation to initial LVM index (LVMi) in 4693 hypertensive outpatients (age 53±11 yrs, 43% women, 5% diabetic) from the Campania Salute Network, with at least 1 yr follow-up (mean 4±3yrs) and free of prevalent CV disease. BP was considered uncontrolled when systolic BP≥140mmHg or/and diastolic BP≥90mmHg (or BP≥130 or/and 80 mmHg with diabetes [ADA guidelines]) at the last available outpatient visit.
Results: Uncontrolled BP despite treatment with ≥2 antihypertensive agents, was found in 2240 patients (48%). Patients with uncontrolled BP were older, more often obese (28% versus 21%) and diabetic (9% versus 1.6%), had longer duration of hypertension and higher baseline BP, heart rate, LVMi, and prevalence of LVH (36% versus 26%, all p<0.0001), with no difference in sex distribution. Of 1440 patients with baseline LVH, 803 (or 56%) were uncontrolled at follow- up, compared to 44% of those without LVH (p<0.0001). In multivariate analyses, odds of uncontrolled BP increased significantly with higher baseline systolic BP, heart rate, BMI, duration of hypertension, presence of diabetes (all p<0.0001) and greater baseline LVMi (OR=1.10/10 g×m^−2.7, 1.04–1.20, p=0.002) independent of age, gender and number of medications. When specific classes of medications were added in the previous model, only use of anti-Renin-Angiotensin System reduced the risk of uncontrolled BP control (OR=0.83, 0.71–0.95, p=0.01), with no impact for other classes of drugs (diuretics, β-blockers, Ca++-channel blockers and α-blockers).
Conclusion: In a large clinical population sample of treated hypertensive patients, higher baseline left ventricular mass is significantly associated with risk of uncontrolled BP independently of age, gender, body max index, diabetes and therapy.